fighting for fluoride principles, techniques and information for community water fluoridation...

Fighting for FluorideFighting for Fluoride

Principles, techniques and information Principles, techniques and information for community water fluoridation for community water fluoridation

spokespersonsspokespersons

Jeff Album, Vice President

Public & Government AffairsDelta Dental of California, New York, Pennsylvania & Affiliates

OverviewOverview

Media Relations Principles And Effective Media Relations Principles And Effective Presentation TechniquesPresentation Techniques

Preparing for the OppositionPreparing for the Opposition

Understanding & Framing the Public Policy Understanding & Framing the Public Policy DebateDebate

(Time permitting)(Time permitting)

Media Relations Principles & Media Relations Principles & Effective Presentation TechniquesEffective Presentation Techniques

Staying on MessageStaying on Message (Stick, Bridge, Deflect)(Stick, Bridge, Deflect)

Stick to 3 or 4 talking points. Always know and Stick to 3 or 4 talking points. Always know and state the one you’re speaking to.state the one you’re speaking to.

Fluoridation is good public policyFluoridation is good public policy Fluoridation is safeFluoridation is safe Fluoridation worksFluoridation works Fluoridation is cost-effectiveFluoridation is cost-effective

Bridge to those points in response to all questions.Bridge to those points in response to all questions. ““That question goes to the heart of why Fluoridation is safe…”That question goes to the heart of why Fluoridation is safe…”

Deflect to your points, when questions are biased Deflect to your points, when questions are biased and/or “loaded.”and/or “loaded.”

““While I can’t respond to that, what I can say is this…” or, “You’re While I can’t respond to that, what I can say is this…” or, “You’re question is off base to begin with. What you should ask is… and question is off base to begin with. What you should ask is… and the answer is …”the answer is …”

Media Relations Principles, Media Relations Principles, Effective Presentation TechniquesEffective Presentation Techniques

Don’t Bury Your LeadDon’t Bury Your Lead

In conversation, many people tend to lead with lengthy support In conversation, many people tend to lead with lengthy support statements, followed by a summary that eventually takes them to an statements, followed by a summary that eventually takes them to an actual point.actual point.

With media and/or in most formal public settings, start succinctly With media and/or in most formal public settings, start succinctly with your point, follow briefly with your support, and if time allows, with your point, follow briefly with your support, and if time allows, restate your point to close.restate your point to close.

The media wants short, pithy sound bytes, not facts. In public The media wants short, pithy sound bytes, not facts. In public forums as well, simple phrases offer better traction. Anti-fluoridation forums as well, simple phrases offer better traction. Anti-fluoridation advocates often unravel because they ramble. advocates often unravel because they ramble.

The better-spoken speaker often wins hearts and minds, regardless of The better-spoken speaker often wins hearts and minds, regardless of what they said.what they said.


Stay in Charge Stay in Charge

Set the agenda, don’t wait for questions or play defense; shape the Set the agenda, don’t wait for questions or play defense; shape the debatedebate

Preempt your opponent’s argumentsPreempt your opponent’s arguments ““Fluoridation opponents will tell you it’s not safe, doesn’t work, and is Fluoridation opponents will tell you it’s not safe, doesn’t work, and is

forced medication. They will cite impressive sounding scientific sources, forced medication. They will cite impressive sounding scientific sources, neglecting to mention why the medical and scientific community regards neglecting to mention why the medical and scientific community regards those sources to be flawed, out of date or taken out of context. Don’t allow those sources to be flawed, out of date or taken out of context. Don’t allow these tactics to divert you from your talking points.”these tactics to divert you from your talking points.”

Appeal to your audience’s emotion/sense of caringAppeal to your audience’s emotion/sense of caring After refuting an anti-argument, come back to the unmet needs of children, After refuting an anti-argument, come back to the unmet needs of children,

the human cost of dental disease, or the number of missed school and the human cost of dental disease, or the number of missed school and work hours caused by a preventable disease. Too many fluoridation work hours caused by a preventable disease. Too many fluoridation advocates present their arguments in a clinical, detached fashion, which advocates present their arguments in a clinical, detached fashion, which comes off as arrogant and aloof.comes off as arrogant and aloof.


Resist News “Bias”Resist News “Bias”

Journalists are trained to report two sides to Journalists are trained to report two sides to every controversyevery controversy

Do not acknowledge there is a bona fide “controversy” with the Do not acknowledge there is a bona fide “controversy” with the fluoridation issuefluoridation issue

Coverage of “controversies” confers equal weight to each side, Coverage of “controversies” confers equal weight to each side, leading undecided readers/viewers to conclude both sides are leading undecided readers/viewers to conclude both sides are valid, and be against fluoridation “just in case.” valid, and be against fluoridation “just in case.”

• Plays into the hands of the anti-fluoridation tack, and speaks to why Plays into the hands of the anti-fluoridation tack, and speaks to why the anti’s raise so many different lines of attack.the anti’s raise so many different lines of attack.


Know Their ArgumentsKnow Their Arguments

Most recent osteosarcoma & cancer issuesMost recent osteosarcoma & cancer issues EPA scientists statement / The NRC reportEPA scientists statement / The NRC report FDA’s failure to certify fluoride as safeFDA’s failure to certify fluoride as safe

Toothpaste warning label and ADA advisory on infant Toothpaste warning label and ADA advisory on infant formulaformula

Fluoride as a waste byproductFluoride as a waste byproduct Fluoride only works topicallyFluoride only works topically Fluoride causes fluorosisFluoride causes fluorosis Fluoride aggregate dosage from all sources not Fluoride aggregate dosage from all sources not

considered in 1 ppmconsidered in 1 ppm


Coping with Coping with Scientific MisrepresentationScientific Misrepresentation

Internet is most common source of misinformation likely to be cited Internet is most common source of misinformation likely to be cited by your opponents.by your opponents.

Actual/valid scientific findings are often cited, then taken out of Actual/valid scientific findings are often cited, then taken out of context, and/or valid studies cited that used wrong dosage, wrong context, and/or valid studies cited that used wrong dosage, wrong fluoride type, faulty methodology, or were non-juried.fluoride type, faulty methodology, or were non-juried.

Advocacy Groups like “Environmental Working Group,” or the “EPA Advocacy Groups like “Environmental Working Group,” or the “EPA Union of Scientists” are cited as scientific sources, when they in fact Union of Scientists” are cited as scientific sources, when they in fact do no science and forward a political agenda.do no science and forward a political agenda.


Fighting the “Credibility War”Fighting the “Credibility War”

Opponents will cite various research articles, noted Opponents will cite various research articles, noted health experts and other “facts” gleaned from various health experts and other “facts” gleaned from various sources.sources.

Impossible to respond to every citation raised. Antis can publish any Impossible to respond to every citation raised. Antis can publish any claim they want, while scientists and public health advocates feel bound claim they want, while scientists and public health advocates feel bound to respect scientific method and juried review.to respect scientific method and juried review.

Best not to pretend to be a scientist and point out when your foe is not Best not to pretend to be a scientist and point out when your foe is not either; find ways to question the credentials of the person presuming to either; find ways to question the credentials of the person presuming to present or relay “scientific” evidence. Defer questions of science to present or relay “scientific” evidence. Defer questions of science to respected fluoridation experts available to field calls and inquiries.respected fluoridation experts available to field calls and inquiries.

You can also defer to the last three U.S. Surgeon Generals, the U.S. You can also defer to the last three U.S. Surgeon Generals, the U.S. Center for Disease Control, the World Health Organization and any Center for Disease Control, the World Health Organization and any other recognized, health and science authority with published other recognized, health and science authority with published statements in support of the efficacy and safety of community water statements in support of the efficacy and safety of community water fluoridation.fluoridation.


Understanding & Framing Understanding & Framing the Policy Debatethe Policy Debate

Two Two ScenariosScenarios

When you boil down all the arguments for and When you boil down all the arguments for and against community water fluoridation, the most against community water fluoridation, the most reasonable assertions from either side support reasonable assertions from either side support one of two possible public policy choices. one of two possible public policy choices. These choices are either based on: These choices are either based on:

1.1. Personal Responsibility; orPersonal Responsibility; or

2.2. Community ResponsibilityCommunity Responsibility

The philosophical grounds for fluoridation is The philosophical grounds for fluoridation is based on the notion of community based on the notion of community responsibility to mitigate the community/ responsibility to mitigate the community/ societal costs of dental disease.societal costs of dental disease.

Framing the Policy DebateFraming the Policy Debate

Scenario 1: Scenario 1: Personal Responsibility and Informed ChoicePersonal Responsibility and Informed Choice

Under this scenario, your town/region would opt not to fluoridate the Under this scenario, your town/region would opt not to fluoridate the drinking water because those who want fluoride can get it on their own, for drinking water because those who want fluoride can get it on their own, for example from fluoridated toothpaste, fluoride supplements and dentist example from fluoridated toothpaste, fluoride supplements and dentist office treatments. In this scenario individuals are trusted to make use of office treatments. In this scenario individuals are trusted to make use of available information and take responsibility for their own oral health. available information and take responsibility for their own oral health.

People who support this scenario are concerned about the potential People who support this scenario are concerned about the potential dangers of fluoridation. They view science and experts with a healthy dangers of fluoridation. They view science and experts with a healthy skepticism; they question the scientific evidence for fluoridation, and they skepticism; they question the scientific evidence for fluoridation, and they fear that adding more chemicals to the water supply may have long-term fear that adding more chemicals to the water supply may have long-term consequences that experts do not yet understand. They believe that even consequences that experts do not yet understand. They believe that even if the risks are small it is better to be safe than sorry. They feel that if the risks are small it is better to be safe than sorry. They feel that people should be trusted to make their own choices, instead of having to people should be trusted to make their own choices, instead of having to accept a form of involuntary medication that tampers with nature and accept a form of involuntary medication that tampers with nature and people’s bodies.people’s bodies.

Arguments in Favor of Personal Arguments in Favor of Personal Responsibility and Informed ChoiceResponsibility and Informed Choice

Choice and CommunityChoice and Community People should take responsibility for themselves and their children. People should take responsibility for themselves and their children. We need to respect people’s right to opt out if they have concerns about fluoridation. We need to respect people’s right to opt out if they have concerns about fluoridation.

People who want fluoride treatments can get them on their own.People who want fluoride treatments can get them on their own. Government should not be in the business of forcing mass medication on the public. Government should not be in the business of forcing mass medication on the public.

Science and the EnvironmentScience and the Environment Fluoride is a poisonous chemical – we should not add it to our water supply.Fluoride is a poisonous chemical – we should not add it to our water supply. We should be wary of interfering with nature. There has been enough damage. We should be wary of interfering with nature. There has been enough damage. Why pour fluoride onto our lawns, or use it to wash our cars? Why pour fluoride onto our lawns, or use it to wash our cars? Some dentists and scientists do not support fluoridation. If scientists can’t all agree, we Some dentists and scientists do not support fluoridation. If scientists can’t all agree, we

should not be acting until their differences are settled.should not be acting until their differences are settled.

Cost/BenefitCost/Benefit This option costs nothing. This option costs nothing. The status quo works fine for most people. The status quo works fine for most people.

Useful Things to Know to Help RefuteUseful Things to Know to Help Refute

Most area residents are exposed to small amounts of fluoride todayMost area residents are exposed to small amounts of fluoride today

Most water supplies naturally contain about 0.2 - 0.4 ppm of fluoride. (Find out what Most water supplies naturally contain about 0.2 - 0.4 ppm of fluoride. (Find out what your levels are)your levels are)

Packaged foods and drinks processed in fluoridated areas contain some fluoride. Packaged foods and drinks processed in fluoridated areas contain some fluoride.

Most people use fluoridated toothpaste. Most people use fluoridated toothpaste.

Most dentists agree that fluoridated toothpaste alone won’t give people the level Most dentists agree that fluoridated toothpaste alone won’t give people the level of fluoride needed for optimal protection. For optimal effect, residents can useof fluoride needed for optimal protection. For optimal effect, residents can use

Fluoridated mouthwash (Fluoridated mouthwash (cost/yearcost/year)) Fluoridated bottled water (about $450/year for a family of 4 [delivered])Fluoridated bottled water (about $450/year for a family of 4 [delivered]) Dentist office treatments (Dentist office treatments (cost/yearcost/year)) Fluoride supplement tablets for children (available with a doctor’s prescription) Fluoride supplement tablets for children (available with a doctor’s prescription) ($37/year)($37/year)

Policy Implications & FactsPolicy Implications & Facts

Policy Implications & FactsPolicy Implications & Facts

Too much fluoride has widely acknowledged and completely controllable risks:Too much fluoride has widely acknowledged and completely controllable risks:

Young children swallowing too much can develop enamel fluorosis, leading to Young children swallowing too much can develop enamel fluorosis, leading to mottling. Health experts consider this a cosmetic issue. 25% of children in the US mottling. Health experts consider this a cosmetic issue. 25% of children in the US have some enamel fluorosis and only 1% have visible stains on the teeth. have some enamel fluorosis and only 1% have visible stains on the teeth.

Fluorosis is almost always caused by swallowing toothpaste (contains 1000 ppm Fluorosis is almost always caused by swallowing toothpaste (contains 1000 ppm of fluoride) or misuse of supplements. of fluoride) or misuse of supplements.

In U.S., fluorosis does not occur more frequently in fluoridated areas.In U.S., fluorosis does not occur more frequently in fluoridated areas.

Some suggest fluoridated water is associated with health problems including Some suggest fluoridated water is associated with health problems including cancer, osteoporosis and kidney disease. Studies do not bear this out.cancer, osteoporosis and kidney disease. Studies do not bear this out.

Tooth decay has declined significantly in the U.S. over the last 50 years. Most experts Tooth decay has declined significantly in the U.S. over the last 50 years. Most experts attribute this to fluoridation in water and in toothpaste. In 2004, more than three-quarters attribute this to fluoridation in water and in toothpaste. In 2004, more than three-quarters of Americans (78%) said they brush their teeth twice a day, and 50% said they floss. of Americans (78%) said they brush their teeth twice a day, and 50% said they floss.

Useful Things to Know to Help RefuteUseful Things to Know to Help Refute

Arguments Against Personal Arguments Against Personal Responsibility and Informed ChoiceResponsibility and Informed ChoiceChoice and CommunityChoice and Community

We’ve educated people about taking care of their teeth for decades, yet tooth decay We’ve educated people about taking care of their teeth for decades, yet tooth decay is still epidemic. Something must be done. is still epidemic. Something must be done.

Individual rights are important, but the greater good of the community comes first, Individual rights are important, but the greater good of the community comes first, especially when there is little potential harm and great potential gain.especially when there is little potential harm and great potential gain.

Most of us lead very complicated lives already – we should make things easier for Most of us lead very complicated lives already – we should make things easier for people where we can. Making young children take fluoride supplement tablets is people where we can. Making young children take fluoride supplement tablets is difficult – many parents would just as soon skip the aggravation.difficult – many parents would just as soon skip the aggravation.

Science and the environmentScience and the environment Fluoride at the right dosage Fluoride at the right dosage benefitsbenefits our health by preventing tooth decay. our health by preventing tooth decay.

Fluoridated drinking water comes nowhere near levels known to cause problems. Fluoridated drinking water comes nowhere near levels known to cause problems.

Fluoride is already found in nature; some cities’ water are naturally fluoridated. Fluoride is already found in nature; some cities’ water are naturally fluoridated. There is no reason to believe it will be harmful.There is no reason to believe it will be harmful.

There is no evidence that fluoridated water harms the environment. Lawns, gardens There is no evidence that fluoridated water harms the environment. Lawns, gardens and wildlife are fine in fluoridated communities.and wildlife are fine in fluoridated communities.

Science is almost never unanimous. There is more agreement about fluoridation in Science is almost never unanimous. There is more agreement about fluoridation in the scientific community than about any other public health measure. the scientific community than about any other public health measure.

Arguments Against Personal Arguments Against Personal Responsibility and Informed ChoiceResponsibility and Informed Choice

Cost/BenefitCost/Benefit Reducing tooth decay in our community will save us money in the long run. Reducing tooth decay in our community will save us money in the long run.

Decay drives up everyone’s dental bills, employer’s dental insurance costs, and Decay drives up everyone’s dental bills, employer’s dental insurance costs, and drives up everyone’s taxpayer expenses for publicly supported insurance drives up everyone’s taxpayer expenses for publicly supported insurance programs (federal Medicaid and State Children’s Health Insurance Program).programs (federal Medicaid and State Children’s Health Insurance Program).

Dental disease leads to lost productivity and reduced earning potential for many Dental disease leads to lost productivity and reduced earning potential for many members of our community. members of our community.

Scenario 2:Scenario 2:Rely on Community Responsibility and Science-Based PoliciesRely on Community Responsibility and Science-Based Policies

Under this scenario, your area’s drinking water should be fluoridated so Under this scenario, your area’s drinking water should be fluoridated so that everyone – especially the young, the old and low-income families – that everyone – especially the young, the old and low-income families – receives at least one of the basic components of good oral health. In this receives at least one of the basic components of good oral health. In this scenario, your community as a whole is acting to improve oral health for scenario, your community as a whole is acting to improve oral health for all its residents, and sparing the community as a whole the expense of all its residents, and sparing the community as a whole the expense of treating dental disease through government supported programs.treating dental disease through government supported programs.

People who support this scenario understand that adding fluoride to the People who support this scenario understand that adding fluoride to the community’s drinking water is a cost-effective, scientifically supported and community’s drinking water is a cost-effective, scientifically supported and safe way of preventing tooth decay. They trust the scientific evidence in safe way of preventing tooth decay. They trust the scientific evidence in support of fluoridation, and they feel that the community should take support of fluoridation, and they feel that the community should take advantage of a technology that has improved the lives of millions of advantage of a technology that has improved the lives of millions of Americans over the last 50 years. They feel that the community has not Americans over the last 50 years. They feel that the community has not only the right but the responsibility to make such decisions for the greater only the right but the responsibility to make such decisions for the greater good, even if some people object.good, even if some people object.

Most dentists and public health experts say adding fluoride to the drinking water is the Most dentists and public health experts say adding fluoride to the drinking water is the most effective way to prevent cavities because everyone – even people who don’t go to most effective way to prevent cavities because everyone – even people who don’t go to the dentist or take good care of their teeth – gets optimal doses of fluoride throughout the dentist or take good care of their teeth – gets optimal doses of fluoride throughout the day. the day.

• Dental health experts say that there would be significantly fewer cavities if fluoride Dental health experts say that there would be significantly fewer cavities if fluoride levels were raised to 0.8 ppm, which remains low enough to avoid unwanted side levels were raised to 0.8 ppm, which remains low enough to avoid unwanted side effects, even with other fluoride sources accounted for.effects, even with other fluoride sources accounted for.

Fluoride is added to drinking water at the treatment plant, at the same time as chlorine Fluoride is added to drinking water at the treatment plant, at the same time as chlorine and various other additives. Adding fluoride is no different then adding these other and various other additives. Adding fluoride is no different then adding these other chemicals to promote the common good. chemicals to promote the common good.

Water quality is monitored to make sure it meets clean water standards. Water quality is monitored to make sure it meets clean water standards.

The water will look, smell and taste the same as it does now.The water will look, smell and taste the same as it does now.

Useful Things to Know in SupportUseful Things to Know in Support

Community Responsibility Community Responsibility and Science-Based Policiesand Science-Based Policies

Community Responsibility and Science-Based Policies

Communities that have introduced fluoridation in recent years have Communities that have introduced fluoridation in recent years have seen a 30-60% drop in tooth decay among young children and a 15-seen a 30-60% drop in tooth decay among young children and a 15-35% drop in decay among teenagers and adults. 35% drop in decay among teenagers and adults.

Children and adults will still need to use fluoridated toothpaste and Children and adults will still need to use fluoridated toothpaste and visit the dentist in order to maintain the best oral health.visit the dentist in order to maintain the best oral health.

Children who currently take fluoride supplements will no longer need Children who currently take fluoride supplements will no longer need the extra fluoride. They will need to stop taking supplements in the extra fluoride. They will need to stop taking supplements in order to reduce their risk of developing enamel fluorosis.order to reduce their risk of developing enamel fluorosis.

Useful Things to Know in SupportUseful Things to Know in Support

Arguments in favor of Community Arguments in favor of Community Responsibility and Science-Based PoliciesResponsibility and Science-Based PoliciesChoice and CommunityChoice and Community

This simple step improves everyone’s health without people having to think about it This simple step improves everyone’s health without people having to think about it or change their daily lives in any way. or change their daily lives in any way.

The community has a responsibility to use all reasonable means to improve the The community has a responsibility to use all reasonable means to improve the health and well-being of its members, especially the most vulnerable. health and well-being of its members, especially the most vulnerable.

Under this scenario, everyone, and especially the young, the old and the medically Under this scenario, everyone, and especially the young, the old and the medically underserved receive one component of good oral health: fluoride.underserved receive one component of good oral health: fluoride.

Science and the environmentScience and the environment Water fluoridation has been in practice for over fifty years, providing plenty of time Water fluoridation has been in practice for over fifty years, providing plenty of time

and opportunity to study risks to both health and environment. None observed.and opportunity to study risks to both health and environment. None observed. Fluoride occurs naturally in our water; community water fluoridation is only the Fluoride occurs naturally in our water; community water fluoridation is only the

slight adjustment of naturally occurring element to obtain the maximum benefit.slight adjustment of naturally occurring element to obtain the maximum benefit.

Cost/BenefitCost/Benefit Fluoridating the drinking water is most cost-effective way to reduce tooth decay –Fluoridating the drinking water is most cost-effective way to reduce tooth decay –

costing households only fifty cents a year. costing households only fifty cents a year. One filling costs roughly the same as fluoridating water over a lifetime for a single One filling costs roughly the same as fluoridating water over a lifetime for a single

resident. Every $1 spent on fluoridated water saves almost $40 in treatment costs.resident. Every $1 spent on fluoridated water saves almost $40 in treatment costs.

Questions?Questions?

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